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HomeMy WebLinkAboutFood Service Establishment Inspection 10 (18) Establishment: Yi Inspection Date: Time: REinsp Address/City: �-J ijitG Health Dept:41 13 c class: 1 2 Based on an inspection this day,the items marked DNC identify the violations in operation or facilities which must be corrected by the date specified on page 2. RISK FACTOR ITEMS:Listing is not inclusive of all possible debatable items C WO N/A DNC �; C[complies] N/O[not observed] NIA[not applicable] 64 6tt €ed�0©d QpdN g DNC[does not comply] 0[other] RTE[ready-to-eat] 61 b�es!9naWAtternate� 2 � � sa el ie er ors refitted C N10 NSA 4 -' 62 Written documentation of traiimag program n�{' 2 A Food workers have no exposed infected lesions/burns 1 Approved source,wholesome,nonadulterated Wo lA 4 B Personnel with infection restricted C Communicable disease of worker reported to local health director 01 A Approved shellfish,finfish,meat&poultry USDA approved B Food cans in good condition(not dented,rusty,bloated,leaking) 1° ded} andsWss �ran C NO WA 4 C Wholesomelnonadulterated foods/safe A Handwash facilities in all food prep/dispensing&warewash areas D Commercial products(no home grown/canned food) B Handwash facilities in or immediately adjacent to toilet rooms E Potentially hazardous foods received at proper temperature C Handwash facilities accessible/convenient to use 0 D Personnel hands washed,clean/Proper handwash procedure �'SAINid/1 C YVAA on E Handwashing at appropriate times 3 Poteutvalty h* ous"f p iatrgstaret pfsp�ruon, fspta, rrrp � ,� ° `Gifr%rc pt aCttces C W0 WA 2= A Hot holding greater than or equal to 140eF. (Whole beef/pork roasts 1300 F.) A ❑ NO eating ❑ No smoking while working B Cold holding less than or equal to 450 F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted .. r. t} .}w � 3sllr. 0 A Approvedsanitizeravailable/adequateconcentrationofsanitizer !°` a2urtow B Food-contact surfaces and utensils used for potentially tempereitwre,therroo�s p btr d 1 t hazardous food sanitized at least every 4 hour A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse B Proper food thermometer for product D Proper sanitizin rocedure Ile C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 0 F�� , C' cUsplay,service and transportat �. A Cloths and/or sponges in good repair and clean Of A Produce washed B Wiping cloths kept in sanitizer between uses B Raw meats not stored/prepared near ready-to-eat foods C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard g Single use gloves changed when soiled E No unauthorized personnel C Food--contact surfaces clean pe F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor TIN 41 Handling of food ntfraittgiw „ . . A No unnecessary handling RTE and/or cooked foods with bare hands 1, A Soap/paper towels/ drying device available B Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands ' C Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice L101 757 O 1 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodborne] PHFs are hot held at: OF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker from working: Are internal cooking temperatures taken? Y N *To what temperature do you cook: Poultry Ground Beef Pork What diseases related to FB illness are you required to report to the local health department? Roasts Other Describe re-heating procedures: Is there a written illness policy that requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases to the QFO? Y N *Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y N Is there a language barrier between inspector&QFO? Y N JLyes indicate language spoken List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered the above questions: Name(print): Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FIN •Obtain signature of the person who received the QFO responsibilities information at the time of the Is there a produce washing policy? Y N *Describe what is washed and inspection: where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 71 Establishment: ri ) � ���Date of Inspection: Address: 00 Y � wner or Operator: / ADDITIONAL FOUR POINT ITEMS . KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. -Potentially hazardous foods not re-served -Operating as required 11 Toxic chemicals. 34 No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly Proper type/installation/backflow prevention devic /air gap for: 4" -Sanitizer concentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines -No unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks Av -Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machines `° Proper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance -Monitoring in compliance designed,properly installed , OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 0 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 4t 2 Vermin Control: No insects/rodents present 2 14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodents 4 Floors:Floor covering installed,constructed as required,good repair,clean j 16 Food-contact surfaces designed,constructed, maintained,installed, 45 Floors graded,drained as required located 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed,maintained, installed,located 71 Mats removable,good repair,clean 18 Single service articles,storage,dispensing 81 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good 1 repair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required # :' 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors x 22 Wash water clean,proper temperature , 53 Rooms&equipment hoods,ducts,vented as required Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean Nonfood-contact surfaces of utensils&equipment clean 2 55 Establishment and premises free of litter,no insect/rodent harborage,Equipment/utensils,storoge,handling no unnecessary articles 32 Proper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly 58 No live birds,turtles,or other animals(except guide dogs) 36 Toilet rooms enclosed with self-closing door 37 Propertoilet fixtures provided,good repair,clean 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean ❑Routine Inspection ❑Reinspection ❑ Preoperational Inspection INSPECTOR: Fnaltu I Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating si ture � � I� � print name print name J— ( DATE CORRECTIONS DUE: phone n ber title Page 2 of 2 plus�_continuation pages Focused Inspection 1/2002 • Pag-X3 of 3 INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION &J, �s 9,,,H— INSPECTION 11-1 FORM# REMARKS Oro 14 17 l INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White'-Health Department 2nd-Yellow-Owner/Manager